The sciatic nerve gets a really bad rap for any pain in the lower back, backside or down the back of the leg. And often, it is the root cause of some significant discomfort. But before you jump to that conclusion about a pain in your butt, consider piriformis syndrome.
The piriformis is a muscle deep in the middle of your backside. As spine-health.com explains, it:
- Starts at the lower spine and connects to the upper surface of each femur (thighbone)
- Functions to assist in rotating the hip and turning the leg and foot outward
- Runs diagonally, with the sciatic nerve running vertically directly beneath it (although in some people the nerve can run through the muscle).
If it is inflamed, swollen, torn or otherwise injured, it can cause a literal, severe pain in the butt after a lot of walking, running, hiking or sitting. If you’re in motion, it will hurt most as you extend your foot to take a step, especially if you’re going uphill. If you’re sitting, it will hurt more as time passes–a long car ride or flight can be excruciating. Once it’s inflamed, these activities will be painful much more quickly than before.
Masquerading as something different
It’s tempting to at first blame a hamstring, a hip flexor, a psoas or the sciatic nerve, because these are more familiar. And with piriformis syndrome, the injured muscle can compress the sciatic nerve, leading to that tingling, throbbing ache down the back of your leg and sometimes into your foot.
So how do you know if it’s your piriformis that’s giving you fits? It’s often a diagnosis of exclusion; meaning, the doctor can’t find any other reason for your pain. But it’s definitely a cause to consider if you’ve had long-term pain that doesn’t seem to match other descriptions.
Treatment is primarily stretching: pigeon pose as shown in the photo here, supine twist, or figure four on the floor (also known as supine pigeon). Resting the muscle can help, as can compression and anti-inflammatories. A foam roller can be a godsend, as well as a cushion under your seat when traveling. Severe cases may require corticosteroid or Botox injections to relax the muscle.